Imagine Technical Institute Student Application

Student Application

Page 1 of 5
Student Information
Student Status
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState (two letter)

Postal / Zip Code (five digit)
Mobile*

Area CodePhone Number
Work

Area CodePhone Number
Home

Area CodePhone Number
Other

Area CodePhone Number
Email*
example@example.com
Work Email
example@example.com
Other Email
example@example.com

Vocational Profile

Page 2 of 5
Which one of ITI's vocational programs interests you the most? *
Do you have the right to work in the United States of America?
Have you ever received funding from any of the following:*
DDRB = Development Disabilities Resource Board (Hold Ctrl for multiple Options)
Do you receive Social Security or Medicaid?*
If yes the Benefits case manager will contact you to set up a meeting.
Do you have an ABLE account?
To learn more about ABLE accounts visit: http://www.ablenrc.org/about/what-are-able-accounts
Tell us how you will get to class at ITI and then to your new job.*
Transportation
Accommodations
ITI is committed to helping our students get the accommodations they require to experience success with their new career. This is why we want to know about any accommodations you need to be successful.
What accommodations do you require?
Hold Ctrl to select more than one
Use this space to explain any accommodations selected above
Guardianship
Do you have a legal guardian?*
Legal Guardian = A person who has been appointed by a judge
What is your guardian's first name?
First name only
What is your guardian's last name?
Last name only
What sort of relationship do you have with your guardian?
Street Address
What is your guardian's street address?
City
In what city does your guardian live?
State
Two letter postal abbreviation (Ex: OK, KS, MO, CA)
Zip/Postal Code
Five digit zip code
What is your guardian's phone number?

Area CodePhone Number
What is your guardian's email address?
example@example.com

Criminal History

Page 3 of 5
Having a criminal record does not necessarilly disqualify you from attending Imagine Technical Institute. We simply ask prospective students to be honest since failure to disclose criminal history could disqualify students from future job placement opportunities.

Furthermore, all Imagine Technical Institute applicants are subject to a criminal background screening prior to enrollment to protect both our students' valuable time and the community employers we partner with who may not hire people under certain legal circumstances.
Do you have any criminal offenses to report?*
If yes, please explain in detail the nature of your offense(s). *
If no type N/A
Are you currently indicted or have current charges?*
If yes, please explain. *
If no type N/A
Do you have any sex-related offenses?*
If yes, please explain.*
If no type N/A

Commitment to Diversity

Page 4 of 5
Imagine Technical Institute is committed to having a zero-tolerance policy for discrimination based on any demographic information provided in this application. This information is gathered solely for the purpose of striving to serve a student population that closely reflects the members of our community. Therefore, the applicant, by providing this information, understands that all information provided below is voluntary.
Gender
Date of Birth*

MonthDayYear
Select the date you were born
Race/Ethnicity
Veteran Status

Final Questions

Page 5 of 5
What other vocational interests do you have?
Hold Ctrl to select more than one option
How did you hear about ITI?*
If you selected "Other", please put here how you heard of us.
If you selected "Other School District", please use this box to tell us which one.
I hereby declare that the provided information in this application is true. I also hereby consent to ITI contacting me through the contact information provided in this application.

Clear
Sign Here
I helped complete this application:
Complete this if you are completing this application on someone's behalf. Otherwise, leave blank.
Application Date:*

MonthDayYear
Please select the current date
Verify you are not a robot!*
Should be Empty:

Student Application

Student Information

Vocational Profile

Accommodations

Guardianship

Criminal History

Commitment to Diversity

Final Questions